Concept Of Illness Research Articles

Precolonial Igbo Voices in Akwaeke Emezi’s Freshwater (2018): A Palimpsestic Search for “Home”

The present article examines how Freshwater (2018), the debut novel of the Nigerian writer Akwaeke Emezi, offers a layered portrayal of precolonial Igbo and western narratives. By recourse to the auto-fictional narrative mode, the fiction deploys a constant tug of war which suggests the culturally hybrid nature of discourses connected to spiritual belief, self-identity dynamics and gender. My analysis pivots around three main discussions. Firstly, I trace and exemplify the aesthetic and thematic imbrication between Igbo cosmology (and Animism) and Christianity. Secondly, I seek to evince the unconventional depiction of plural consciousnesses coexisting in an individual in an effort to contest long-established truisms of self formation. I also focus on the ensuing amalgam between western conceptions of mental illness, trauma and Igbo mystic interpretations of reality. Considering the peripheral Igbo stance the novel depicts, the fiction will be contextualised within the current literary meta- and trans-modernist axis. Thirdly, I refer to transgender issues mapped up and brought to the fore through the main character’s predicament; a search for existential answers commingling divergent paradigms. Thus, Freshwater offers a peculiar polyphony of numinous narratorial voices which strive to question extant (neo)postcolonial truths.

Identifying barriers to care to inform Lassa Fever health policies in rural Nigeria

Abstract Lassa fever (LF) is an emerging viral haemorrhagic disease endemic to West Africa that can potentially cause a global pandemic. Nigeria has experienced yearly LF outbreaks since 2012 and the 2018 outbreak recorded an unprecedented number of cases and deaths. A critical gap in controlling neglected tropical diseases such as LF is our limited understanding of how people access care and how structural and cultural factors constitute barriers to care. This study examines concepts of illness and healthcare-seeking behaviours to investigate these barriers. From October to December 2019, we conducted a mixed-methods community-based study consisting of 51 interviews, 21 focus groups, and direct observations, in 5 villages of a 2018 LF hotspot in Ebonyi state, Nigeria. Participants' perceived severity and frequency of diseases aligned with the current biomedical understanding. In contrast, some diseases were associated with witchcraft or bad behaviours. Most participants knew LF disease but denied its yearly recurrence. In addition, LF victims and caregivers suffered from a strong stigmatisation. We identified a mismatch between preferred and actual healthcare-seeking behaviours. Most participants preferred hospital care but defaulted to traditional healers and patent medicine vendors (chemists). Reasons reported were high care fees, life-sustaining jobs conflicting with commuting time to hospitals, and a low English literacy. Age and education correlated with healthcare-seeking behaviours: elder and less formally educated people preferred traditional healers. LF-related stigma reportedly impacted timeliness and adequacy of care during the 2018 outbreak. Participants had a good knowledge of the diseases and true barriers to care came from structural factors and LF-related stigma. This led to mismatches between disease knowledge and healthcare-seeking behaviours. Awareness campaigns may have a limited impact if they focus on disease knowledge without addressing barriers to care. Key messages To enhance LF detection and control, LF policies in rural Nigeria should focus on barriers to care through public health messaging addressing stigma and through bringing care closer to remote areas. This community-based study illustrates the importance of understanding the socio-cultural ecology of the diseases to inform evidence-based and locally adapted strategies for disease control.

Epistemic injustice in the age of evidence-based practice: The case of fibromyalgia

The aim of this paper is to analyze epistemic interactions in healthcare practices. In clinical encounters, participants exchange and interpret knowledge. Patients suffering from fibromyalgia often report that healthcare professionals do not take their testimonies and interpretations seriously. Such experiences will be explored using the concept of epistemic injustice. Epistemic injustice is wrong done to someone in their capacity as a knower. In healthcare settings, epistemic injustice occurs when patients experience an unjustified discrediting as unreliable informants of their own illness experiences. First, we will argue that patients’ epistemic marginalization can be reframed as an epistemological problem. There is a gap between patients’ lived experience of illness and professionals’ conceptualization of illness as disease. This gap leads to two distinct conceptualizations, possibly causing harm to patients’ capacity as first-hand knowers. Second, we will analyze epistemic injustice in light of the dominant model of knowledge translation in medicine and healthcare, namely evidence-based practice (EBP). EBP intends to diminish the gap between scientific knowledge and clinical practice. EBP prioritizes knowledge obtained through clinical research over other forms of clinical knowledge and has the potential for harmful epistemic devaluation of patients’ stories.

The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care.

Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.

Belief in Brua among psychiatric patients from Aruba, Bonaire, and Curaçao: Results from an explorative study in the Netherlands.

Brua is an Afro-Caribbean religion and healing tradition predominantly practised on the ABC islands of the former Netherlands Antilles. It is grounded in oral tradition and shrouded in strict social taboos. Existing literature suggests that the majority of people on and from the islands are familiar with Brua and that it plays a substantial role in shaping their illness conception and idioms of distress. A lack of knowledge of Brua may therefore lead biomedically trained health professionals to misdiagnose these patients. This article discusses how religious beliefs related to Brua influence the illness concepts and idioms of distress of psychiatric patients originating from the ABC Islands, based on semi-structured interviews with former islanders receiving treatment at a psychiatric institute in the Netherlands. We found that of the 29 interviewees, 93.1% knew what Brua involved, 72.4% believed in it, 48.2% had first-hand experience with Brua practices, and 34.5% attributed their mental illness to Brua with greater or lesser certainty. However, only one patient had previously discussed her belief in Brua with her psychiatrist and only when asked to do so. The role of psychoactive substances in the context of Brua practices was negligible. Thus, the present study indicates that the majority of psychiatric patients from the ABC islands are familiar with Brua, but feel reluctant to discuss their concerns in this area with mental health professionals. Recommendations for clinical practice and further research are provided, including the need for a culture-sensitive approach and integrative care.

Sociocultural influences on asthma self-management in a multicultural society: A qualitative study amongst Malaysian adults.

BackgroundSupported self‐management improves asthma outcomes, but implementation requires adaptation to the local context. Barriers reported in Western cultures may not resonate in other cultural contexts. We explored the views, experiences and beliefs that influenced self‐management among adults with asthma in multicultural Malaysia.MethodsAdults with asthma were purposively recruited from an urban primary healthcare clinic for in‐depth interviews. Audio‐recordings were transcribed verbatim and analysed thematically.ResultsWe interviewed 24 adults. Four themes emerged: (1) Participants believed in the ‘hot and cold’ concept of illness either as an inherent hot/cold body constitution or the ambient temperature. Hence, participants tried to ‘neutralize’ body constitution or to ‘warm up’ the cold temperature that was believed to trigger acute attacks. (2) Participants managed asthma based on past experiences and personal health beliefs as they lacked formal information about asthma and its treatment. (3) Poor communication and variable advice from healthcare practitioners on how to manage their asthma contributed to poor self‐management skills. (4) Embarrassment about using inhalers in public and advice from family and friends resulted in a focus on nonpharmacological approaches to asthma self‐management practice.ConclusionsAsthma self‐management practices were learnt experientially and were strongly influenced by sociocultural beliefs and advice from family and friends. Effective self‐management needs to be tailored to cultural norms, personalized to the individuals' preferences and clinical needs, adapted to their level of health literacy and underpinned by patient–practitioner partnerships.Patient and Public ContributionsPatients contributed to data. Members of the public were involved in the discussion of the results.

Closed-Loop Neuromodulation and Self-Perception in Clinical Treatment of Refractory Epilepsy

Background: Newer “closed-loop” neurostimulation devices in development could, in theory, induce changes to patients’ personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment. Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program and collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception. Results: Participants generally did not attribute changes in patients’ personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients’ experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians. Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients’ illness experiences and social circumstances.

Changing Psychiatry or Changing Society? The Motion for the Rights of the "Mentally Ill" in Greece, 1980-1990.

In 1980, the first formal association of mental patients, their relatives, and mental health professionals was founded in Athens, Greece. The Motion for the Rights of the “Mentally Ill” proposed a total restructuring of mental health care and a novel conceptualization of mental illness. On the one hand, it demanded that the mental health system be based on open services, psychotherapy, and on patients’ active participation in all decisions concerning their treatment and life. On the other hand, it conceptualized mental illness as a political issue that concerned all. Thus, the Motion viewed the promotion of the rights of the mentally ill as part of a broader project of cultivating conscious, active, and collective citizenship. This paper traces the Motion’s history during the 1980s, showing that it was shaped by both the socio-political conditions of Greece in the post-dictatorship period, a time of intense politicization, and by the legacy of mental patient activism in the Western world during the 1970s and 1980s. It argues that, although the Motion had a limited long-term impact, it represented the mental patient movement in Greece as it furthered the latter’s main features, most importantly its twofold endeavor to change not only the mental health system and the attitudes towards mental illness, but also society.

Counseling a patient presenting gastrointestinal symptoms in the circumstances of a limited range of available medication – social aspects

The health and illness concepts have a major significance for both the patient and the healthcare specialists. Therefore, the role of the pharmacist is an extremely important one and, during the pandemic times, the relationship between the pharmacist and the patient has further expanded. The healthcare specialist should personalize the medical treatment plan for each individual patient, in order to obtain maximum efficiency with the lowest possible risk. Approximately 20% of all patients infected with SARS-CoV-2 present gastrointestinal symptoms, such as loss of appetite, nausea, vomiting or generalized abdominal pain. Any treatment recommendation made by the pharmacist should take into consideration general aspects regarding the intensity and the localization of the pain, as well as any chronic or acute treatment that the patient may undergo, all relevant medical history and the immediate prognosis of the disease.

“In fact I am an animal”: Mental Illness, Vulnerability and the Problem of Empathy in Anna Kavan's Asylum Piece

ABSTRACT This article explores Anna Kavan's critique of psychiatry in Asylum Piece (1940), a collection of stories which draws from her struggle with mental illness and her internment in a psychiatric clinic in the late 1930s. In this work, an aestheticization of vulnerability and a perplexing model of empathy are established. Kavan's conception of mental illness as a state of powerlessness leaves society – and by extension humanity – complicit with the psychiatric regime of oppression, and so she turns to non-human and “subhuman” subjectivities for safety and compassion. Unlike Derrida, then, for whom the gaze of the non-human other precipitates the deconstruction of one's identity, for Kavan the gaze of the non-human is restorative. The article examines the ethical implications of this gesture and proposes that Kavan's mentally ill be read as an other whose radical alterity demands to be acknowledged empathetically and unconditionally.

The impact of absenteeism and the relationship with emotional absence based on individual stories

The relationship between the concepts of stress, mental illness and burnout syndrome seems to be indistinguishable when it comes to work leave by individuals who present specific and common symptoms. Recent research has shown an increase in absenteeism as a pandemic in society, one of the main problems faced by organizations, the consequences of illness generated by lack of emotional health, and the emergence of such symptoms arising from these relationships. This study analyzes the discourse of individuals diagnosed with burnout syndrome, seeking to identify the multiple relationships between the underlying symptoms and emotional health problems, a new concept discussed by theorists in recent years. For research purposes, elements of qualitative methodology were used. The narratives were analyzed considering psychoanalysis, and supported by the social interpretation of the reports. The results showed a significant trend towards a relationship between the concepts, the subject studied and the stories told in the interviews, leading us to reflect on the emotional impact of these relationships on work environments, individuals and society.

Why Are Psychiatrists Hesitant to Refer Patients For Interventional Treatments?

Why Are Psychiatrists Hesitant to Refer Patients For Interventional Treatments?

Is it normal to be depressed in old age? Needs assessors' conceptions of older people's mental illness.

The article contributes to the research on older people's mental illness through its focus on how needs assessors conceive mental illness amongst older people and their strategies for dealing with mental illness within existing organisational frameworks. The contribution is based on an empirical study of the needs assessment in eldercare in Sweden. The article aims to explore needs assessors' conceptions of mental illness amongst older people in relation to intertwining processes of normalisation and organisational and legal constraints. The normalisation principle (NP) proposes that individuals with a disability should have access to the same living conditions as 'others'. The NP can be described as a strategy that highlights equal rights for individuals regardless of their life situation. The main findings are that mental illness is defined by needs assessors on a spectrum of diagnoses from schizophrenia and borderline personality disorder to anxiety and depression. The successful normalisation of mental illness is linked to structural context, attitudes to older people's mental illnesses and ageing, the practise established on a unit and whether needs assessors reproduce ageism or challenge it through the NP by attempting to secure the rights of older people.

Transcultural Psychiatry: Cultural Difference, Universalism and Social Psychiatry in the Age of Decolonisation

In the mid-twentieth century, in the aftermath of WWII and the Nazi atrocities and in the midst of decolonisation, a new discipline of transcultural psychiatry was being established and institutionalised. This was part and parcel of a global political project in the course of which Western psychiatry attempted to leave behind its colonial legacies and entanglements, and lay the foundation for a more inclusive, egalitarian communication between Western and non-Western concepts of mental illness and healing. In this period, the infrastructure of post-colonial global and transcultural psychiatry was set up, and leading psychiatric figures across the world embarked on identifying, debating and sometimes critiquing the universal psychological characteristics and psychopathological mechanisms supposedly shared among all cultures and civilisations. The article will explore how this psychiatric, social and cultural search for a new definition of ‘common humanity’ was influenced and shaped by the concurrent global rise of social psychiatry. In the early phases of transcultural psychiatry, a large number of psychiatrists were very keen to determine how cultural and social environments shaped the basic traits of human psychology, and ‘psy’ practitioners and anthropologist from all over the world sought to re-define the relationship between culture, race and individual psyche. Most of them worked within the universalist framework, which posited that cultural differences merely formed a veneer of symptoms and expressions while the universal core of mental illness remained the same across all cultures. The article will argue that, even in this context, which explicitly challenged the hierarchical and racist paradigms of colonial psychiatry, the founding generations of transcultural psychiatrists from Western Europe and North America tended to conceive of broader environmental determinants of mental health and pathology in the decolonising world in fairly reductionist terms—focusing almost exclusively on ‘cultural difference’ and cultural, racial and ethnic ‘traditions’, essentialising and reifying them in the process, and failing to establish some common sociological or economic categories of analysis of Western and non-Western ‘mentalities’. On the other hand, it was African and Asian psychiatrists as well as Marxist psychiatrists from Eastern Europe who insisted on applying those broader social psychiatry concepts—such as social class, occupation, socio-economic change, political and group pressures and relations etc.—which were quickly becoming central to mental health research in the West but were largely missing from Western psychiatrists’ engagement with the decolonising world. In this way, some of the leading non-Western psychiatrists relied on social psychiatry to establish the limits of psychiatric universalism, and challenge some of its Eurocentric and essentialising tendencies. Even though they still subscribed to the predominant universalist framework, these practitioners invoked social psychiatry to draw attention to universalism’s internal incoherence, and sought to revise the lingering evolutionary thinking in transcultural psychiatry. They also contributed to re-imagining cross-cultural encounters and exchanges as potentially creative and progressive (whereas early Western transcultural psychiatry primarily viewed the cross-cultural through the prism of pathogenic and traumatic ‘cultural clash’). Therefore, the article will explore the complex politics of the shifting and overlapping definitions of ‘social’ and ‘cultural’ factors in mid-twentieth century transcultural psychiatry, and aims to recover the revolutionary voices of non-Western psychiatrists and their contributions to the global re-drawing of the boundaries of humanity in the second half of the twentieth century.

Unveiling the Forbidden: Exploration of the Uncanny ‘Other’ in Bollywood Films

The paper explores how multiple personality disorder and schizophrenia are represented in selected Hindi films (Karthik Calling Karthik. Bhool Bhulaiyaa, Aparichit, Madhoshi) and how they affect the attitudes of the common people. Psychoanalytic theory is employed to analyze the concept of mental illness as depicted in these films. The protagonist in the films is a sufferer of either multiple personality disorder, schizophrenia, or mental illness, and these psychological states are central themes. After analyzing the films, it could be stated that Bollywood has moved beyond presenting religious rituals as a cure to mental illness. Psychiatrists gained importance in Hindi films, successfully representing some of the symptoms of multiple personality disorder and schizophrenia. However, the films just mention the treatment procedures and presented them as an easy method. Hence projecting the treatment of mental disorders in Hindi films remains less serious and fictional. Filmmakers should research and investigate the real patients, their families, and doctors before making films on mental illness.

Targeting hyperinflammation in infection: can we harness the COVID-19 therapeutics momentum to end the dengue drugs drought?

The COVID-19 pandemic has accelerated potential therapeutics into clinical trials at a remarkable pace. It has also brought global attention to the concept of a biphasic illness with an initial viraemic phase, followed by a life-threatening inappropriate and excessive host hyperinflammatory phase in some patients, which might respond to immunomodulation. In this subgroup, a self-amplifying cytokine storm is thought to lead to monocyte and macrophage activation, with subsequent tissue damage, clinically manifesting as fever, organ dysfunction, elevated ferritin, cytopenias, and hyper-cytokinaemia.

Views and Perceptions toward Mental Illness: A Qualitative Study from a Rural, Agricultural Community in Anuradhapura, Sri Lanka

Community’s perception toward mental illness is a major determinant of stigma and discrimination toward mental illness, ignorance, delayed help-seeking attitude, and treatment options. Conceptions of mental illness are often influenced by sociocultural structures and health literacy among communities. Despite the increased burden of mental health problems, little is known about knowledge and perception of the public toward mental illness in rural communities in Sri Lanka. A community-based qualitative study was conducted in a rural, agricultural community in the district of Anuradhapura, in North-Central province of Sri Lanka to explore perception and attitudes toward mental illness. Eight individual, in-depth, semi-structured interviews and one group interview were conducted among a convenient sample of 15 lay community members. The data were analyzed using qualitative content analysis method. Participants described their views and perceptions toward conceptualizing mental illness under four themes, namely, causes of mental illness, complementary treatment methods, stigma and social discrimination, and supporting factors for mental well-being. Poverty, bad relationships, and beliefs influenced by sociocultural and religious background were considered as the main causes of mental illness. Misconceptions, stigma, and discrimination of mentally ill people and their families delayed help-seeking behavior and caused barriers to mental health-care provision. There is a strong need for increasing mental health literacy and awareness among people in rural communities. People’s sociocultural and religious beliefs should take into account when caring for mentally ill people and their family members.

Health and Illnes Concept in Elderly Age in Munte Village, Munte District, Karo Regency

Abstract: This study discusses the concept of health and illness in the elderly in Munte Village, Munte District, Karo Regency. The purpose of this study was to see how the elderly respond in dealing with disease and to see what things are done to process the prevention and cure of a disease. The method used in this research is ethnography with a qualitative approach with the aim of systematically describing cultural characteristics more deeply in their own space and time. The methods used in data collection are participatory observation and unstructured interviews and use interview guidelines. The results of the study were to see how the elderly interpret health in old age. Traditional medicine that is so attached to their daily lives is a knowledge that is passed down from generation to generation. The role of the family is very important in supporting the health of the elderly both from a social, economic and psychological perspective.

What is mental illness?- Historical discussion in the research field and prospects for the concept of mental illness based on Wakefield’s interpretation -

What is mental illness?- Historical discussion in the research field and prospects for the concept of mental illness based on Wakefield’s interpretation -

‘Hawa’ and ‘resistensiya’: local health knowledge and the COVID-19 pandemic in the Philippines

Understanding people’s concepts of illness and health is key to crafting policies and communications campaigns to address a particular medical concern. This paper gathers cultural knowledge on infectious disease causation, prevention, and treatment the Philippines that are particularly relevant for the COVID-19 pandemic, and analyzes their implications for public health. This paper draws from ethnographic work (e.g. participant observation, interviews, conversations, virtual ethnography) carried out individually by each of the two authors from February to September 2020. The data was analyzed in relation to the anthropological literature on local health knowledge in the Philippines. We find that notions of hawa (contagion) and resistensiya (immunity) inform people’s views of illness causation as well as their preventive practices - including the use of face masks and ‘vitamins’ and other pharmaceuticals, as well as the ways in which they negotiate prescriptions of face mask use and physical distancing. These perceptions and practices go beyond biomedical knowledge and are continuously being shaped by people’s everyday experiences and circulations of knowledge in traditional and social media. Our study reveals that people’s novel practices reflect recurrent, familiar, and long-held concepts - such as the moral undertones of hawa and experimentation inherent in resistensiya. Policies and communications efforts should acknowledge and anticipate how these notions may serve as either barriers or facilitators to participatory care and improved health outcomes.